CHAPTER 10: Retaining Sobriety

1. CHAPTER 10:Retaining Sobriety Substance Abuse Counseling: Theory and Practice Fifth Edition Patricia Stevens Robert L. Smith Prepared by: Dr. Susan Rose, University of the Cumberlands

2. Overview of Chapter • Introduction • Determinants of Relapse • Models of Relapse Planning and Management • Self-Help Recovery Organizations: Adjuncts to Professional Intervention

3. Introduction • Definitions • Recovery: not only abstinence from mind-altering chemicals or nonproductive compulsive behaviors but also as changes in physical, psychological, social, familial, and spiritual areas of functioning. • Relapse has many definitions. • A breakdown or setback in a person’s attempt to change or modify a target behavior. • The act or an instance of backsliding, worsening, or subsiding. • A recurrence of symptoms of a disease after a period of improvement. • The continuous return to ATOD use or to the dysfunctional patterns of compulsive behavior.

4. Introduction • Relapse can be seen in two dimensions: • The “event” • The “process” • Definitions • Lapse: the initial return to use after a period of sobriety. • Concept Change • Most now view relapse as a normal part of the recovery process and as a learning experience for the recovering individual.

5. Determinants of Relapse • Environmental • High-risk situations threaten the client’s control and increase the likelihood of return to use: • Negative emotional states • Interpersonal conflict • Social pressure • Environmental stimuli • Craving • Behavioral • Clients who have few or no coping skills to respond to these high-risk situations are more likely to return to substance use.

6. Determinants of Relapse • Cognitive Variables that affect relapse • Individual’s attitude toward sobriety (motivation to quit or not) • Individual’s perception of his/her ability to cope (self-efficacy) • Expectation of relapse • Affective • Research identifies negative affect as the major cause of relapse. • Two very strong emotions that must be dealt with in recovery are shame and guilt. • Recognizing that positive emotional states also create stress is imperative when working with this population.

7. Determinants of Relapse • InterpersonalDeterminants • The lack of a supportive family or social network has been highly correlated with a return to substance use. • The family is usually the primary relationship and, therefore, the relationship that is most harmed in the process of abuse and dependency. • If family is not involved in recovery process, results can be devastating. • Other components that may create a problem in recovery: • Work • Leisure Time

8. Models of Relapse Planning and Management • The Disease Model • Developed by Jellinek in the 1940’s • Alcoholics Anonymous (AA) adopted this model of addiction recovery • Developmental Models • Gorski views addiction as a chronic and progressive disease The Gorski Model’s Six steps: • Transition • Stabilization • Early recovery • Middle recovery • Late recovery • Maintenance

9. Models of Relapse Planning and Management • Developmental Models • The model assumes that change is intentional on the part of the individual. • The Stage Model’s Stages of Change • Precontemplation • Contemplation • Determination • Action – When client becomes abstinent for first time • Maintenance • This transtheoretical model assumes that change is cyclical and dynamic.

10. Models of Relapse Planning and Management • Cognitive-Behavioral/Social Learning Model • Social Learning Theories • Primary learning principle is operant conditioning. • Another social theory perspective examines the effect of psychological stress on substance use. • Important of self-efficacy in social learning theory • Cognitive Behavioral Model • Premise of Relapse Prevention (RP) model is that individuals attempt to stop or reduce substance use will face risks of relapse. • Relapse is seen as a learning tool.

11. Models of Relapse Planning and Management: Cognitive Behavioral Model cont. • Cognitive Behavioral Model • Ward and Stewart’s Good Lives Model recognizes 10 primary good that every individual needs to pursue: • Healthy living • Knowledge • Excellence in play and work • Excellence in agency • Inner peace • Friendship • Community • Spirituality • Happiness • Creativity

12. Models of Relapse Planning and Management: Cognitive Behavioral Model cont. • Cognitive Behavioral Model • Abstinence Violation Effect (AVE) create cognitive dissonance • Involves self-attribution effect

13. Self-Help Recovery Organizations: Adjuncts to Professional Intervention • Alcoholics Anonymous Model • Giving up control to gain control • Making Amends • Group Participation • AA Outcome Studies • Spirituality as a Resource • Spirituality can be a helpful resource for understanding a past lifestyle of substance abuse and for making decisions about a future free from addiction.

14. Self-Help Recovery Organizations: Adjuncts to Professional Intervention • AA-Associated 12-Step Programs • All are based on the AA philosophy and use a variation of the 12 steps of AA. • The difference is their scope. • Moderation Management (MM) • Based on the cognitive behavioral model • Views moderate use as success • Specific Guidelines for participation in the program (Table 10.2, page 279) • Harm Reduction Model

15. Self-Help Recovery Organizations: Adjuncts to Professional Intervention • Rational Recovery • Developed as an alternative for individuals who had difficulty with the spiritual aspect of AA • Based in cognitive-behavioral theory on the work of Albert Ellis • Used framework of Rational Emotive Therapy • Secular Organizations for Sobriety/Save Our Selves (SOS) • Claims to be a self-empowerment approach based on the belief that sobriety is an issue apart from any other issues in the person’s life.

16. Self-Help Recovery Organizations: Adjuncts to Professional Intervention • Women for Sobriety (WFS) • A group founded by women for women • Self-help for Dually Diagnosed Persons • Nearly 50% of persons diagnosed with a mental illness have a co-existing substance abuse or dependence disorder. • Self-help groups that have been started to help dually diagnosed individuals: • Double Trouble in Recovery • Dual Recovery Anonymous • Special AA meetings for alcohol-dependent individuals with a mental disorder • SMART

17. Self-Help Recovery Organizations: Adjuncts to Professional Intervention • A Well-Rounded Life with Joy • Addicts must learn to manage their “pleasure threshold” • Ward and Stewart’s “Good Lives Model”